Senator Schumer: Government-run health insurance won't drive private insurers out of business

[w¡n9Nµ7 §£@¥€r 123]

WASHINGTON — In an effort to defuse the most explosive issue in the debate over comprehensive health care legislation, a top Senate Democrat has proposed that any new government-run insurance program comply with all the rules and standards that apply to private insurance.

The proposal was made Monday by Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, in a bid to address fears that a public program would drive private insurers from the market.

...

Senate Democrats are looking for a middle ground that would address the concerns of political moderates. One way they propose to do that is by requiring the public plan to resemble private insurance as much as possible.

“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market.

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Insurers ... remain skeptical. Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of Congress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.

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Mr. Schumer set forth these principles:

* The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

* The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

* The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

* To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.

But some thorny questions remain. Could states tax the premiums of a public plan, as they tax private insurance premiums? Would the public plan have to comply with state laws, as private insurers do? Would the government ever allow the public plan to become insolvent?

In the pursuit of universal coverage, liberal Democrats say, it would be a mistake to rely entirely on the same insurance companies that have profited by selecting healthier customers, avoiding sick people and refusing to pay many legitimate claims.

http://www.nytimes.com/2009/05/05/health/p...y/05health.html

[Trumplestiltskin 5,791]

I have to admit if Obama's plan fits the model described during the campaign, I have to say I'm not a fan.

The system needs bold and radical overhaul, not the little bit of tweaking here and there. McCain's plan was actually more radical than Obama's - even if it was in the wrong direction.

[w¡n9Nµ7 §£@¥€r 123]

The system needs bold and radical overhaul, not the little bit of tweaking here and there.

You don't think the establishment of a publicly run insurance program to compete with private insurers would be radical?

[Trumplestiltskin 5,791]

The system needs bold and radical overhaul, not the little bit of tweaking here and there.

You don't think the establishment of a publicly run insurance program to compete with private insurers would be radical?

I think it amounts to papering over the cracks.

[AlHayatZween 2]

can someone just explain something i seem to be missing:

why isn't anyone addressing cost? for example, if insurance (private or public) were more affordable, a lot of us could purchase our own. and what about the random pricing of some procedures? i will give you an example from our latest medical fiasco: my husband needs surgery on his gums. the cost billed to the insurance company is $650 per quadrant of his mouth. if we didn't have insurance, we'd get billed $980 per quadrant for the same procedure, same specialist, same everything.

why isn't anyone addressing the issue of medical costs & the lack of transparency of pricing procedures?

[Trumplestiltskin 5,791]

can someone just explain something i seem to be missing:

why isn't anyone addressing cost? for example, if insurance (private or public) were more affordable, a lot of us could purchase our own. and what about the random pricing of some procedures? i will give you an example from our latest medical fiasco: my husband needs surgery on his gums. the cost billed to the insurance company is $650 per quadrant of his mouth. if we didn't have insurance, we'd get billed $980 per quadrant for the same procedure, same specialist, same everything.

why isn't anyone addressing the issue of medical costs & the lack of transparency of pricing procedures?

Because its more difficult. McCain talked about lowering costs but none of the things he suggested in his plan would have facilitated it.

[AlHayatZween 2]

can someone just explain something i seem to be missing:

why isn't anyone addressing cost? for example, if insurance (private or public) were more affordable, a lot of us could purchase our own. and what about the random pricing of some procedures? i will give you an example from our latest medical fiasco: my husband needs surgery on his gums. the cost billed to the insurance company is $650 per quadrant of his mouth. if we didn't have insurance, we'd get billed $980 per quadrant for the same procedure, same specialist, same everything.

why isn't anyone addressing the issue of medical costs & the lack of transparency of pricing procedures?

Because its more difficult. McCain talked about lowering costs but none of the things he suggested in his plan would have facilitated it.

But if we can't lower the costs, then aren't we just chasing our own tails?

[Trumplestiltskin 5,791]

can someone just explain something i seem to be missing:

why isn't anyone addressing cost? for example, if insurance (private or public) were more affordable, a lot of us could purchase our own. and what about the random pricing of some procedures? i will give you an example from our latest medical fiasco: my husband needs surgery on his gums. the cost billed to the insurance company is $650 per quadrant of his mouth. if we didn't have insurance, we'd get billed $980 per quadrant for the same procedure, same specialist, same everything.

why isn't anyone addressing the issue of medical costs & the lack of transparency of pricing procedures?

Because its more difficult. McCain talked about lowering costs but none of the things he suggested in his plan would have facilitated it.

But if we can't lower the costs, then aren't we just chasing our own tails?

Yep.

[w¡n9Nµ7 §£@¥€r 123]

It's true. The same procedure can have any number of widely divergent costs depending on who's paying. If a government-run health insurance program doesn't get good pricing, then it will fail.

[Trumplestiltskin 5,791]

It's true. The same procedure can have any number of widely divergent costs depending on who's paying. If a government-run health insurance program doesn't get good pricing, then it will fail.

There was a TV commercial I saw in CA that showed two old men going to a pharmacy counter and being charged wildly different amounts for the exact same thing. That $hit is just crazy. I couldn't imagine how people tolerate that - it seems somewhere along the road they got whipped (and decided that they like it).

[AlHayatZween 2]

So then it's all just ####### then...?

Most regular people will never be able to afford health insurance, unless provided through an employer? And now, even that is if-fy...

[w¡n9Nµ7 §£@¥€r 123]

It's true. The same procedure can have any number of widely divergent costs depending on who's paying. If a government-run health insurance program doesn't get good pricing, then it will fail.

There was a TV commercial I saw in CA that showed two old men going to a pharmacy counter and being charged wildly different amounts for the exact same thing. That $hit is just crazy. I couldn't imagine how people tolerate that - it seems somewhere along the road they got whipped (and decided that they like it).

The airlines get away with it.

So then it's all just ####### then...?

Most regular people will never be able to afford health insurance, unless provided through an employer? And now, even that is if-fy...

It may turn out to be #######, yes.

For now, make your concerns known to your congressman. This will be an epic battle, fought the old fashioned way, with slush funds and faxes and phonecalls.

[Trumplestiltskin 5,791]

The US will never abandon private insurance. And the Obama administration has yet to prove that its willing to break with the past and make the sort of radical changes that were promised in the election campaign. For all the talk of how Liberal Obama is, he's been pretty middle of the road so far.

[AlHayatZween 2]

There was a TV commercial I saw in CA that showed two old men going to a pharmacy counter and being charged wildly different amounts for the exact same thing. That $hit is just crazy. I couldn't imagine how people tolerate that - it seems somewhere along the road they got whipped (and decided that they like it).

Yes, it is tragic but true.

Simple blood tests for things that have been the same for the past 20 years (Thyroid panel, as an example) cost nearly double if you don't have insurance and are paying out of pocket.

[Trumplestiltskin 5,791]

I'm still PO'd that I was charged $300 out of pocket for a 5 minute appt with an ENT doctor who put a stick up my nose.